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Herniation Syndromes

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Topic updated on 05/01/14 12:31am

Overview
  • A result of increased intracranial pressure
    • coma or death when brainstem herniates
  • Types
    • cingulate (subfalcine)
      • pressure by falx cerebri
      • presentation
        • ischemia due to occlusion of anterior cerebral artery
    • cerebellar tonsillar
      • pressure by foramen magnum
    • downward transtentorial (central)
      • pressure by tentorium cerebelli
      • presentation
        • compression of CN VI results in diplopia and inability to abduct eye
        • ischemia due to arterial compromise
    • uncal (medial temporal lobe)
      • pressure by tentorium cerebelli
      • presentation triad
        • blown pupil (fixed and dilated) + ptosis
          • compression of CN III
          • can also result in "down-and-out" eye
        • ipsilateral hemiplegia
          • compression of contralateral cerebral peduncle
        • coma
      • can also result in
        • contralateral homonymous hemianopia
          • result of compression of ipsilateral posterior cerebral artery
        • duret hemorrhages
          • result of paramedian artery rupture

 

 



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